Obesity Differential Diagnosis Table

Abnormal or excessive fat accumulated over the body is known as obesity. Usually one speaks of obesity when the body mass index (BMI) is over 30. It is not a disease itself but leads to many fatal diseases like high blood pressure, heart disease, diabetes etc. This happened due to lack of exercise, healthy diet and bad lifestyle. But sometimes there can be other reasons for being obese.

The most common cause of obesity is overeating. In this way, the body gets more fats and sugars, while these calories are not burned and stored in the body, especially in the muscles, due to lack of exercise and physical activities.

Sometimes genetics and stress play a major role in a person’s physical appearance and lead to obesity. Aging and a person’s daily lifestyle have a very direct impact on the body. Obesity is treatable, but it has become difficult for a person who becomes obese due to their genetics.

Diabetes is treatable, but the doctor may need to run some tests to identify the true cause of the obesity. There are some common tests for some common diseases that can lead to obesity. These are thyroid tests, diabetes screening, and blood tests to check cholesterol levels.

Obesity Differential Diagnosis Table:

Obesity is defined as excessive weight associated with increased morbidity and mortality. Obesity is a chronic metabolic disease with frequent progressiveness, as well as diabetes or hypertension. Obesity is defined as a body mass index (BMI) over 30 kg/m2.

It is a multifactorial disease; among the risk factors are included: Age, being female, race (more frequent in Afro-descendants), unhealthy habits, sedentary lifestyle, sociocultural factors, genetic factors, and medications.
Based on body mass index (BMI), it classifies in:
Overweight: BMI (25-28 kg/m2)
Mild obesity: BMI (28-30 kg/m2)
Moderate obesity: BMI (30-35 kg/m2)
Severe or morbid obesity: BMI (+35 kg/m2)

The most notorious symptom is overweight, but others may be: dyspnea, depression, fatigue, back or joint pain, lack of sleep, etc. The main signs are: acanthosis nigricans, waist circumference greater than 94 cm in men and 88 cm in women, and high blood pressure levels.

How to Distinguish Obesity from Other Diseases

Distinguish Hypothyroidism from Obesity – Diagnosis

Hypothyroidism is defined as the deficiency of thyroid hormones to meet the needs of the body.

• Hypothyroidism symptoms are: fatigue, cold intolerance, weight gain, menstrual irregularity, joint pain, skin and hair loss, depression, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.
• During physical examination, a hypothyroidism patient presents: an enlarged thyroid gland, hypertension (diastolic hypertension), bradycardia, rough hair, jaundice, while in obesity, it is rare.
• Hypothyroidism is an autoimmune disease, unlike obesity, which is a multifactorial disease.

Distinguish Cushing’s Syndrome from Obesity – Diagnosis

Cushing’s syndrome is a hormonal disorder due to excess cortisol.

• Cushing’s syndrome symptoms are muscle weakness, buffalo hump, short height, hypertension, gonadal dysfunction, menstrual irregularities, osteoporosis, poor wound healing, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.
• Cushing’s syndrome is characterized by having central obesity while obesity can occur in a proportionate way.

Distinguish Insulin Resistance from Obesity – Diagnosis

Insulin resistance is a metabolic condition in which peripheral tissues present resistance to this hormone. Insulin resistance is also known as pre-diabetes.
Insulin resistance symptoms are: increased thirst, increased fatigue, blurred vision, weight loss, urge to urinate, increased appetite, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.

Distinguish Polycystic Ovary Syndrome (PCOS) from Obesity – Diagnosis

Polycystic ovary syndrome is a condition characterized by high levels of androgens in women.

• There are three vital characteristics in polycystic ovary syndrome: absence of ovulation, high levels of androgens, and ovarian cysts, while in obesity, those characteristics are not necessarily present.
• Polycystic ovary syndrome symptoms include menstrual irregularities, infertility, hirsutism, central obesity, oily skin, abdominal pelvic pain, acanthosis nigricans, acne, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.

Distinguish Leptin Deficiency from Obesity – Diagnosis

Leptin deficiency is an autosomal recessive disease in which there is a mutation in the leptin gene.

• Leptin deficiency is a genetic condition, unlike obesity, which is a multifactorial disease.
• Patients with Leptin deficiency, unlike obesity, have a delay of puberty or do not go through it, causing infertility.
• Patients with Leptin deficiency quickly develop obesity in the first months of life, unlike obesity where patients can acquire this weight gain at any stage of their life since it is a multifactorial condition.
• Leptin deficiency symptoms are severe obesity, severe hyperphagia, endocrine abnormalities such as hypogonadism, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.

Distinguish Growth Hormone Deficiency from Obesity – Diagnosis

Growth hormone deficiency is the insufficient production of growth hormone that is released by the pituitary gland.

• Growth hormone deficiency is associated with genetic mutations or brain injuries, while obesity is a multifactorial disease.
• Growth hormone deficiency, unlike obesity, can present these symptoms during the neonatal period: hypoglycemia, micropenis, jaundice, prominent forehead, hypoplastic nasal bridge, delay in dentition.
• Growth hormone deficiency adult symptoms are: short stature, low bone density, reduced muscle mass, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.

Distinguish Hypothalamic Disorders from Obesity – Diagnosis

Hypothalamic disorders are alterations that occur at the level of the hypothalamus due to a tumor or hormonal deregulation.

• Some of the most common symptoms seen in hypothalamic disorders are: impotence, constipation, weight gain, hair loss, depression, fatigue, menstrual irregularities, high blood pressure, weight loss, water retention, while obesity symptoms are dyspnea, depression, fatigue, back or joint pain, lack of sleep.
• Hypothalamic disorders are due to the growth of uncommon brain tumors, unlike obesity, where although it is a multifactorial condition, the growth of tumors is not one of them.

Distinguish Prader-Willi Syndrome from Obesity – Diagnosis

Prader-Willi Syndrome is a rare genetic disorder that causes alterations in the patient’s mental and behavioral physical development.

• Prader-Willi Syndrome produces an important finding and is constant polyphagia that begins around two years of age, although in obesity there is polyphagia as well, it is not common to present it at such an early age.
• Prader-Willi Syndrome produces developmental symptoms such as late development learning, developmental disability, delayed speech, short stature, while obesity does not produce those symptoms.
• Prader-Willi Syndrome produces behavioral symptoms such as aggression, self-mutilation, while obesity does not produce those symptoms.
• Prader-Willi Syndrome produces flat muscles, apnea, small feet, scoliosis, while obesity does not necessarily produce those symptoms.

Distinguish Lipodystrophy Syndromes from Obesity – Diagnosis

Lipodystrophy syndrome is a rare disease characterized by the loss of adipose tissue in specific places of the body, especially in the extremities.

• Lipodystrophy syndrome, unlike obesity, produces physical changes such as lipoatrophy in the face, arms, legs, and hypertrophy mostly in the trunk, neck, buffalo hump.
• Lipodystrophy syndrome produces metabolic changes: Increased cholesterol, fatty liver, pancreatitis, kidney disease, diabetes, while in obesity, although obesity is a risk factor for multiple metabolic diseases, it does not necessarily mean that an obese person has these metabolic conditions, although the chances of having them are higher than a person who is not obese.

Common Red Flags with Obesity

Obesity is the second cause of death after tobacco.
Physical activity should be encouraged, healthy habits such as a balanced diet, get a good amount of sleep, activities to manage stress.
It is important to educate the patient about the consequences of this condition, the secondary chronic diseases it brings with it (hypertension, diabetes, cardiovascular and cerebrovascular diseases, alterations in lipid profile).

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